Subcutaneous tranexamic acid for bleeding associated with a mycotic aortic aneurysm

We describe the case of a 64-year-old woman with haemoptysis due to a mycotic thoracic aneurysm, with probable fistulation into the lung and oesophagus. Continuous subcutaneous tranexamic acid was used at the end of life to minimise bleeding associated with this, once the oral route was lost. A 1.5 g of tranexamic acid was administered, diluted with 23 mL water for injection in a 30 mL syringe, as a continuous subcutaneous infusion over 24 hours. Bleeding ceased rapidly following administration. There was no further bleeding in the last days before death and no site reaction noted. This case report adds to the growing evidence base for the use of subcutaneous tranexamic acid in a palliative care setting. However, further research is needed to support this practice both in terms of efficacy and safety, but also terms of compatibility and stability when administered by continuous subcutaneous infusion.